Dr Krishnaveni Nayini

Endoscopic Surgeries

What is Endoscopy?
Endoscopy is a procedure in which your doctor uses specialized instruments to view and operate on the internal organs of your body, without making large incisions. Endoscopic surgeries allow easier recovery time, and less pain and discomfort.
Endoscopy in Obstetrics and Gynaecology
• Technological and medical advances have led to the use of Endoscopy in Gynaecology & Obstetrics.
• Endoscopy has many applications in modern gynaecology, in both diagnostic and therapeutic aspects and the list is growing every year.
• Gynaecological endoscopy employs specially designed and miniature instruments to help diagnose gynaecological disorders and pathologies.
• Endoscopic surgery by means of special equipment enables doctors to operate inside the body without the need for open surgery. This has greatly reduced patient discomfort in the past few years.
There are three types of endoscopic surgery in obstetrics and gynaecology: Laparoscopy; Hysteroscopy; and Salpingoscopy.
What is Laparoscopy?
Laparoscopy is a minimally invasive surgical procedure that allows the surgeon to access the internal organs without having to make large cuts on the skin.
Since laparoscopy uses minimal cuts, it is also known as key-hole surgery.
How is it performed?
Laparoscopy is performed with the aid of an instrument called a Laparoscope. A laparoscope is a thin tool that has a video camera and light at the end of it. This instrument is inserted inside the body through the small cut made by the surgeon which helps them visualise the internal organs clearly on a monitor.
Laparoscopy in Gynaecology
Laparoscopy in gynaecology can be used for both diagnosis and treatment. Diagnostic laparoscopy can help your gynaecologist visualise the internal organs thereby allowing them to see if you have a condition such as endometriosis, fibroids, polyps, or any other abnormal findings, and as a treatment, it helps your doctor perform multiple surgical procedures.
Miniature instruments of laparoscopy can help your doctor perform a variety of surgeries including:
• Removal of ovarian cyst
• Hysterectomy (removal of the uterus)
• Surgical contraception
• Removal of ovaries
• Removal of fibroids
• Removal of ectopic pregnancy
• Endometrial tissue ablation
• Blockage of blood flow to fibroids
• Surgery to treat prolapsed uterus
Laparoscopy may also be used to diagnose:
• Endometriosis
• Uterine fibroids
• Ovarian cysts or tumors
• Ectopic pregnancy
• Pelvic abscess, or pus
• Pelvic adhesions
• Cause of Infertility
• Pelvic inflammatory disease
• Cancer of reproductive organs

What to expect during laparoscopy?
The following is done during the procedure:
• General anaesthesia is given- but one can expect an early discharge from the hospital
• A catheter is inserted to collect the urine, and the abdomen is filled with a harmless gas (carbon dioxide) through a needle
• The surgeon makes a small cut and inserts the laparoscope inside which transmits clear and magnified views of the internal organs on a screen. The video can also be recorded for future reference
• In case a surgical procedure is done through laparoscopy then additional cuts may be made through which additional instruments are inserted to perform the surgery
• After the procedure, the instruments are removed and incisions are closed using stitches
Since laparoscopy needs minimal invasion, early discharge and minimal tissue trauma are expected.
What is Hysteroscopy?
Hysteroscopy is the exam of the inside of the cervix and uterus using a thin, lighted, flexible tube called a hysteroscope.
Your doctor may advise you on a Hysteroscopy if during examination any pathology is suspected in the uterus and cervix area. Abnormal bleeding, repeated miscarriages, abnormal Pap test result, etc, can be a reason for hysteroscopic examination
During Hysteroscopy your doctor may:
• Take a tissue sample (biopsy)
• Remove polyps or fibroid tumors
• Prevent bleeding by destroying tissue using electric current, freezing, heat, or chemicals
Depending on the reason to perform hysteroscopy it can diagnostic or operative.
What to expect during a hysteroscopy?
The following can be expected during a hysteroscopy procedure:
• You will be asked to empty your bladder and lie down comfortably in the procedure room
• An intravenous (IV) line may be put in your arm or hand.
• The vaginal area will be cleaned with an antiseptic solution.
• Your doctor will insert the hysteroscope into the vagina, through the cervix, and into the uterus. At times, your doctor may decide to dilate your cervix before inserting the hysteroscope.
• Your doctor will inject a liquid or gas through the hysteroscope to expand the uterus for a better view.
• Your doctor will examine the wall of the uterus for problems. He or she may take photographs or videos and take tissue samples (biopsies).
• In case removal of fibroids is needed then your doctor may insert additional instruments through the hysteroscope.
• After the procedure is done the hysteroscope is carefully removed.
Benefits of hysteroscopy?
Advantages of hysteroscopy include:
• Shorter hospital stay when compared to conventional procedures
• Shorter recovery time
• Less discomfort and pain
• Avoidance of hysterectomy and open surgery
What is Salpingoscopy?
Salpingoscopy, as a pre-operative diagnostic tool, is useful in examining the tubal cavity. The Salpingoscopy technique allows the direct evaluation of the ampullary tubal mucosa at the time of laparoscopy. It has been reported that the presence of ampullary mucosal adhesions can negatively affect the reproductive outcome and increase the risk of ectopic tubal pregnancy. Salpingostomy is thus a vital tool in visualising such tubal abnormalities.
What to expect during Salpingoscopy?
In the Salpingoscopy procedure a fiberoptic endoscope – salpingoscope is inserted through the cervical canal after making the patient comfortable on the operating table.
• The uterus and fallopian tubes can be visualized directly by your doctor.
• During the procedure, your doctor can examine and diagnose or even treat obstructions, adhesions, or other diseases and conditions of the tubal area. Salpingoscopy has allowed the improved selection of patients who are candidates for tubal surgery.
• After careful visualization and therapy, the salpingoscope is carefully removed.
Dr. Krishnaveni Nayini has vast experience of over two decades in performing various endoscopic surgical procedures. She is a senior obstetrician and gynaecologist practicing in Hyderabad, India.